Good Afternoon,
I'm hoping someone can help me with this. I've been trying to find a code for this procedure and I am not sure if i'm headed in the right direction with this. Provider states he's doing a small bowel bypass, gastrostomy and repair ventral hernia with mesh placement in a patient with short gut syndrome. I was previously advised to look at the gastric bypass codes but the ones I'm looking at all say 'for morbid obesity' but that's not applicable for this case . I've posted the operative description below for review. Any help or direction on this would be greatly appreciated!!
PROCEDURE:"Following smooth induction of general endotracheal anesthesia, Foley catheterization, and wide prep of the abdomen with ChloraPrep, 4 towels, Ioban and laparotomy sheet, with IV antibiotics having been administered, incision was made in the hypogastrium below the chronically eschared area above, which had been treated well with a wound VAC. So in the hypogastrium, incision was carried through the skin and subcutaneous, linea alba. This allowed entry into the peritoneum, which was completely obliterated. Careful dissection allowed to free it all up and then allowed us to dissect superiorly the fibrotic peel off of the small intestines. At this end of careful dissection, eventually the distal ileum and junction to the cecum was identified and from distal to proximal dissection demonstrated the rest of the small intestine. In the jejunum just beyond the ligament of Treitz, there were previous anastomoses made where the obstruction was. This was obliterated with phlegmon. Enough of the small intestine had been freed up distally so that a side-to-side anastomosis could be done to bypass this area and this was done with two 3-0 silk sutures and fenestration on each side allowed application of a 60 white load Echelon and this was fired. The access defect was closed with running 3-0 Vicryl and interrupted 3-0 silk sutures and coated with Tisseel. The upper area, which was just a fibrotic peel, then was reinforced with a sheet of Strattice mesh 10 x 16 inches that was introduced to also support the lower wound and it was tacked in position along the fascial edges with #1 PDS suture. Prior to closure, the stomach was freed up proximally and distally, the left upper quadrant well away from all the wounds. A 24-French gastrostomy tube was transmitted into the [_____] pursestring in the stomach and was secured and brought up to the anterior abdominal wall with multiple silk sutures. The lower abdomen was closed with retention running looped PDS and the fibrotic peel then after Strattice was in place was reapproximated with interrupted #1 PDS sutures. A Prevena dressing was placed through the lower part of the wound and Aquacel over the granulation tissue and a Mepilex dressing. The patient tolerated the procedure, extubated, and returned to recovery in stable condition."
I'm hoping someone can help me with this. I've been trying to find a code for this procedure and I am not sure if i'm headed in the right direction with this. Provider states he's doing a small bowel bypass, gastrostomy and repair ventral hernia with mesh placement in a patient with short gut syndrome. I was previously advised to look at the gastric bypass codes but the ones I'm looking at all say 'for morbid obesity' but that's not applicable for this case . I've posted the operative description below for review. Any help or direction on this would be greatly appreciated!!
PROCEDURE:"Following smooth induction of general endotracheal anesthesia, Foley catheterization, and wide prep of the abdomen with ChloraPrep, 4 towels, Ioban and laparotomy sheet, with IV antibiotics having been administered, incision was made in the hypogastrium below the chronically eschared area above, which had been treated well with a wound VAC. So in the hypogastrium, incision was carried through the skin and subcutaneous, linea alba. This allowed entry into the peritoneum, which was completely obliterated. Careful dissection allowed to free it all up and then allowed us to dissect superiorly the fibrotic peel off of the small intestines. At this end of careful dissection, eventually the distal ileum and junction to the cecum was identified and from distal to proximal dissection demonstrated the rest of the small intestine. In the jejunum just beyond the ligament of Treitz, there were previous anastomoses made where the obstruction was. This was obliterated with phlegmon. Enough of the small intestine had been freed up distally so that a side-to-side anastomosis could be done to bypass this area and this was done with two 3-0 silk sutures and fenestration on each side allowed application of a 60 white load Echelon and this was fired. The access defect was closed with running 3-0 Vicryl and interrupted 3-0 silk sutures and coated with Tisseel. The upper area, which was just a fibrotic peel, then was reinforced with a sheet of Strattice mesh 10 x 16 inches that was introduced to also support the lower wound and it was tacked in position along the fascial edges with #1 PDS suture. Prior to closure, the stomach was freed up proximally and distally, the left upper quadrant well away from all the wounds. A 24-French gastrostomy tube was transmitted into the [_____] pursestring in the stomach and was secured and brought up to the anterior abdominal wall with multiple silk sutures. The lower abdomen was closed with retention running looped PDS and the fibrotic peel then after Strattice was in place was reapproximated with interrupted #1 PDS sutures. A Prevena dressing was placed through the lower part of the wound and Aquacel over the granulation tissue and a Mepilex dressing. The patient tolerated the procedure, extubated, and returned to recovery in stable condition."